Abstract
ObjectiveTo use American College of Veterinary Internal Medicine (ACVIM) criteria to evaluate a high-definition oscillometric (HDO) blood pressure monitoring device versus invasive blood pressure (IBP) measurement in normotensive rabbits anaesthetized with two different anaesthetic protocols. Study designProspective experimental study. AnimalsA group of 20 healthy adult New Zealand White rabbits weighing 4.36 ± 0.37 kg (mean ± standard deviation). Materials and methodsRabbits were premedicated with butorphanol 0.5 mg kg–1 and midazolam 0.5 mg kg–1 subcutaneously (SC, group BMA) or ketamine 25 mg kg–1 and medetomidine 0.4 mg kg–1 SC (group KM). Anaesthesia was induced with alfaxalone administered intravenously (group BMA) or isoflurane by face mask (group KM) and maintained with isoflurane in oxygen. IBP was measured from the central auricular artery. The cuff for the HDO monitor was placed distal to the left elbow and distal to the left tarsus. Agreement between invasive and HDO measurements was evaluated using Bland–Altman method. ResultsIn group KM there was better agreement between the HDO device and IBP when the cuff was placed on the thoracic limb, with 100% and 91% of the readings for mean (MAP) and diastolic arterial pressure (DAP), respectively, within 10 mmHg of the IBP measurements. The agreement, although worse, also met the ACVIM criteria for systolic arterial pressure (SAP; 53% of the readings within 10 mmHg). In group BMA, the device met the criteria with the cuff on the thoracic limb only, and only for MAP and DAP (73% and 75% of the measurements within 10 mmHg of the IBP, respectively) but not for SAP (12%). Conclusion and clinical relevanceThe HDO device met most of the ACVIM criteria for noninvasive blood pressure measurement in anaesthetized rabbits, specifically when the cuff was placed distal to the elbow and the anaesthetic protocol included ketamine and medetomidine.
Highlights
According to a large epidemiologic study (Brodbelt et al 2008) and several more recent investigations (Matthews et al 2017; Lee et al 2018), anaesthesia-related mortality is greater in rabbits than in dogs and cats (1.39e4.8% versus 0.05e0.17% and 0.11e0.24%, respectively)
In group KM there was better agreement between the high-definition oscillometric (HDO) device and Invasive blood pressure (IBP) when the cuff was placed on the thoracic limb, with 100% and 91% of the readings for mean (MAP) and diastolic arterial pressure (DAP), respectively, within 10 mmHg of the IBP measurements
In group BMA, the device met the criteria with the cuff on the thoracic limb only, and only for MAP and diastolic blood pressure (DAP) (73% and 75% of the measurements within 10 mmHg of the IBP, respectively) but not for systolic arterial pressure (SAP) (12%)
Summary
According to a large epidemiologic study (Brodbelt et al 2008) and several more recent investigations (Matthews et al 2017; Lee et al 2018), anaesthesia-related mortality is greater in rabbits than in dogs and cats (1.39e4.8% versus 0.05e0.17% and 0.11e0.24%, respectively). Invasive blood pressure (IBP) monitoring, which is considered the ‘gold standard’ for blood pressure measurement, requires insertion of a catheter into the lumen of a peripheral artery. This method is the most accurate and provides additional advantages such as continuous measurement, pressure wave display and access to arterial blood sampling. Oscillometric devices, which measure blood pressure through detection of vessel wall oscillations caused by blood flow, are generally easy to use and can provide information about MAP and DAP. They can become inaccurate at high heart rates or at reduced pulse pressure (Alpert et al 2014)
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